Vision Loss - Central retinal arterial occlusion/Retinal Detachment

Question 1

There are lots of causes of vision loss including optic nerve, retina and the vitreous. Vascular causes of vision loss due to the optic nerve can be:

• Arteritic anterior ischaemic optic neuropathy (A-AION) – Giant Cell Arteritis
• Non-arteritic ischaemia optic neuropathy (N-AION)

What does N-AION resemble to cause vision loss by affecting the optic nerve?

1 - infection
2 - conjunctivitis
3 - allergic reaction
4 - stroke

Answer 1

4 - stroke

N-AION resemble a stroke to the the optic disc caused by occlusion of the anterior ciliary arteries

Question 2

Do patients with Non-arteritic ischaemia optic neuropathy (N-AION) have any giant cell arteritis symptoms?

Answer 2

• no

Question 3

All of the following are risk factors for Non-arteritic ischaemia optic neuropathy (N-AION), EXCEPT which one?

1 - hypertension
2 - ischaemic heart disease
3 - young age
4 - diabetes

Answer 3

3 - young age

Typically affects those over 50 years old

Question 4

Non-arteritic ischaemia optic neuropathy (N-AION), there can be vision loss, which of the types of image loss is present?

Answer 4

• right hand image

This is called an altitudinal field defect

Question 5

In patients with non-arteritic ischaemia optic neuropathy (N-AION), giant cell arteritis (GCA) must be ruled out. Which 3 of the following are used to rule out (GCA)?

1 - temporal biopsy
2 - FBC
3 - CRP
4 - ESR

Answer 5

2 - FBC
3 - CRP
4 - ESR

Question 6

Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) is a common cause of vision loss. Does this typically affect older or younger patients?

Answer 6

• older patients

Typically aged >50 years old

Question 7

Is arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) dangerous?

Answer 7

• yes

An ophthalmic medical emergency

Question 8

Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) can result in vision loss. How does the vision loss typically present?

1 - insidious vision loss in both eyes
2 - sudden loss of vision in both eyes
3 - insidious vision loss in one eye
4 - sudden loss of vision in one eye

Answer 8

4 - sudden loss of vision in one eye

If left untreated can spread and cause vision loss in the second eye

Question 9

Which of the following has the strongest association with Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA)?

1 - sarcoidosis
2 - polymyalgia rheumatica
3 - lupus
4 - RA

Answer 9

2 - polymyalgia rheumatica

Question 10

Which of the following systemic symptoms do patients NOT typically present with in Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA)?

1 - fever >39
2 - jaw claudication
3 - malaise
4 - headache

Answer 10

1 - fever >39

Question 11

In patients with Arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) they can experience a Relative Afferent Pupillary Defect (RAPD). What is the RAPD?

1 - patient has no direct response in eye with lesion
2 - patient has no indirect response in eye with lesion
3 - swing test in affected eye causes pupil dilation
4 - swing test in affected eye causes pupil constriction

Answer 11

3 - swing test in affected eye causes pupil dilation
- lesion in eye that dilates as the lesion is impairing the afferent signal

direct = pupil dilates when light shone in that eye
in-direct/consensual = pupil dilates when light shone in opposite eye

Question 12

Is visual acuity affected in arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA)?

Answer 12

• yes

Question 13

Does arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) affect the optic disc?

Answer 13

• yes

Can cause swelling

Question 14

In arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA), which can cause vision loss, needs to be diagnosed asap. Which of the following is NOT one of the 3 tests that is done urgently?

1 - U&E
2 - FBC
3 - ESR
4 - FBC

Answer 14

1 - U&E

Significantly raised inflammatory markers are present in A-AION

Question 15

Confirmatory diagnosis of arteritic anterior ischaemic optic neuropathy (A-AION), secondary to Giant Cell Arteritis (GCA) is performed using atemporal biopsy. But can the wait for this delay the treatment, which is with steroids?

Answer 15

• no

Oral steroids often given before an official diagnosis is given

Question 16

Central retinal arterial occlusion (CRAO) and central retinal vein occlusion (CRVO) can cause vision loss. In CRVO what is the cause of the vision loss?

1 - vein clots and causes compression of optic disc
2 - vein becomes blocked, bursts causing widespread haemorrhage
3 - vein forms embolism
4 - all of the above

Answer 16

2 - vein becomes blocked, bursts causing widespread haemorrhage

Question 17

Which of the following are risk factors for developing central retinal vein occlusion (CRVO)?

1 - hypertension
2 - ischaemic heart disease
3 - high cholesterol
4 - diabetes
5 - all of the above

Answer 17

5 - all of the above

Question 18

If the blood supply is severely impaired in central retinal vein occlusion (CRVO) is the prognosis fore their vision good or bad?

Answer 18

• bad

Question 19

If the blood supply is severely impaired in central retinal vein occlusion (CRVO) the patients can develop what?

1 - rubeosis iridis
2 - hyphema
3 - neovascular glaucoma
4 - hypopyon

Answer 19

1 - rubeosis iridis

Formation of new blood vessels on the iris

Question 20

Central retinal arterial occlusion (CRAO) and central retinal vein occlusion (CRVO) can cause vision loss. In CRAO what is the cause of the vision loss?

1 - vein clots and causes compression of optic disc
2 - vein becomes blocked, bursts causing widespread haemorrhage
3 - embolism from heart or carotid can occlude the artery
4 - all of the above

Answer 20

3 - embolism from heart or carotid can occlude the artery

Question 21

In Central retinal arterial occlusion (CRAO) what condition must be ruled out as a cause?

1 - diabetes
2 - malignant hypertension
3 - graves disease
4 - giant cell arteritis

Answer 21

4 - giant cell arteritis

Question 22

Patients with In Central retinal arterial occlusion (CRAO) should be referred to which specialist clinic?

1 - diabetic
2 - transient ischaemic attack clinic
3 - cardiology
4 - neurology

Answer 22

2 - transient ischaemic attack clinic

Needed to investigate and manage the patient

Question 23

Looking at the images below, which is Central retinal arterial occlusion (CRAO) and which is Central retinal vein occlusion (CRVO)?

Answer 23

• left = CRVO
• right = CRAO